Behind Bars, Beyond Care: The Health Crisis in Immigration Detention
- Sheila Thompson, RN CPHQ
- 2 hours ago
- 5 min read
At least 30 individuals have died in Immigration and Customs Enforcement (ICE) custody in 2025 as of late December; a 20-year high and more than double the number who died in ICE custody in 2024. According to a 12/19/2025 Reuters report, four deaths occurred between 12/12 and 12/15/25 alone.
The practice of imprisoning individuals detained for immigration-related reasons is nothing new in the United States. Already a world leader in immigration detention, the number of persons detained in the US dramatically increased from 15,000 in early 2021 to approximately 66,000 in late November 2025. Experts predict these numbers will continue to rise due to the current administration’s focus on mass deportation of immigrants. Let us examine the factors that lead to adverse health outcomes in this growing, at-risk population.
Physical Health Impacts
Staffing Issues
Multiple studies describe poor management of medical care in ICE detention facilities, prompting the lead author of one of these studies to comment, “even people who are healthy going in are sick coming out of the system”. Chanelle Diaz, MD, MPH, an internal medicine physician and Assistant Professor of Medicine at Columbia University Irving Medical Center, cited staffing shortages and a lack of qualified health care providers among the factors. She provided examples, including physicians who are not board-certified, a shortage of specialists, unfilled clinical staff positions, an absence of on-site physicians, and LPNs performing triage.
Sub-standard Medical Care
Inadequate medical care and the neglect of pre-existing conditions are common themes across studies. A study published in the Journal of Immigrant and Minority Health noted a lack of adequate work-up, missed or incorrect diagnoses, medication, or treatment, and the lack of needed specialty referrals. Those with chronic conditions such as diabetes, high blood pressure, or HIV, or in a treatment regimen such as chemotherapy for cancer or hormone therapy for gender-affirming care, often experience an exacerbation of their condition or a setback in their regimen due to delay or denial of needed medication or treatment.
Barriers to Accessing Care
Those with acute illnesses describe systemic barriers to accessing care, such as a requirement to submit requests for medical care in writing, which is even more difficult for someone with limited English proficiency, particularly since they are routinely denied interpreter services. Individuals frequently wait weeks and make multiple requests before being evaluated. Even when people receive care, Dr. Diaz described dehumanization perpetrated not just by corrections officers, but also by medical providers, such as never referring to individuals as patients, only as detainees. She noted, “people’s pain was not acknowledged, … people’s symptoms were not believed until they passed out and died”.
Unsanitary Conditions
Those who have been detained report deplorable living conditions, including overcrowding, inadequate and inedible food and water, lack of running water, soap, and toilet paper, and poor ventilation, heat, or cooling. Poor nutrition negatively impacts chronic conditions such as diabetes and high blood pressure, and previously healthy individuals frequently develop new conditions like obesity and high cholesterol due to the unhealthy diet and lack of exercise while detained. Infectious diseases such as COVID-19, influenza, tuberculosis, and gastrointestinal illnesses run rampant, and treatment is typically inappropriate or inadequate. While acutely ill and contagious, people are either left housed with healthy people or are put in solitary confinement. Medication or transfer to a hospital is frequently delayed, sometimes resulting in death.
Mental Health Impacts
Psychological Trauma
Studies reveal that the usual stress of incarceration due to confinement, isolation, violence, and assault is magnified for immigrants in detention for multiple reasons. Inhumane treatment is widespread, with study participants reporting discrimination and neglect based on race and immigration status, resulting in dehumanizing treatment, denial of rights, and the punitive use of solitary confinement. Many had never been incarcerated before and feared being housed with violent criminals. Those who had experienced incarceration previously felt immigration detainment was much worse, primarily due to omnipresent uncertainty.
Almost all immigrants in detention express a sense of injustice, causing moral injury. The majority have no criminal record, yet they are imprisoned for a civil offense and denied due process with no guarantee of legal protections or counsel. They describe constant uncertainty regarding the duration and outcome of their immigration case and detention, and fear of eventual deportation. Many stated they felt the goal was to break them, using fear and inhumane treatment to pressure them to sign deportation papers out of desperation.
Lack of Mental Health Support
Individuals in immigration detention face the same barriers to accessing mental health care as those seeking medical care. People with pre-existing mental health conditions are often poorly assessed, and necessary medication and treatment are delayed or denied. Stress, isolation, and separation from their family, and the emotional and financial impact on family members, add to the strain on mental health. There is a shortage of qualified mental health practitioners, and a person in a mental health crisis is likely to be placed in solitary confinement. Many of the study participants experienced new symptoms of anxiety and depression, and some became suicidal. A study analyzing 69 ICE detainee death reviews for deaths occurring between 2018 and 2025 reports 12 (17%) of the individuals who died were men who committed suicide by hanging.
Vulnerable Groups
Women, children, and LGBTQ+ individuals are at higher risk of trauma, violence, and abuse, including sexual abuse. Study participants reported being targeted due to their sexual orientation and callous disregard for injuries sustained through violence perpetrated by other inmates. Pregnant women suffer from lack of pre-natal care and are at higher risk for pregnancy complications.
Conclusion
Long Term Affects
Immigrants continue to experience difficulty accessing care after release from detention due to poor planning and a lack of health insurance. They are often released with new physical or mental health conditions and unmet needs. Relationships with spouses and children may have been permanently damaged, and the family may face serious financial repercussions if the primary breadwinner was detained. Study participants described being left with a “mental scar” of trauma that persisted long after their release, including nightmares, ongoing fear of ICE coming for them at any time, and never feeling free.
A Call to Action
A key question is whether the system can increase staffing to keep pace with the growing population of immigrants in detention. Even with approximately $70 billion allocated to ICE this past summer to hire staff and expand capacity, recruiting qualified medical and mental health practitioners remains challenging. Departments responsible for detention oversight have been gutted or shut down. There has been a trend over the last decade toward the use of for-profit facilities, primarily in more rural areas. Immigrant advocates purport that U.S. immigration policy is financially and racially driven, as detention has not shown to be a deterrent to immigration, while alternative programs have proven to be cost-effective and successful in ensuring compliance with immigration proceedings. Dr. Diaz noted, “I’ve been shocked and haunted by some of the stories that I’ve heard and seen, … this is happening under our noses, there isn’t awareness of how far-reaching this issue is, and we have a duty and a moral responsibility to really look closely at what we are funding as taxpayers”.
References
Assessed and Endorsed by the MedReport Medical Review Board